Chiropractic Professionalism, Part 1

In recent years, from many quarters, concerns have been expressed about the decline in professionalism among medical doctors, lawyers, accountants, those in other professions, and unfortunately, chiropractors.

In recent years, from many quarters, concerns have been expressed about the decline in professionalism among medical doctors, lawyers, accountants, those in other professions, and unfortunately, chiropractors. Although chiropractic has been in existence for well over 100 years, it has not been successful in gaining from society the respect to which it is entitled. Chiropractic is considered, by many, as an honourable profession, yet at the same time, it is stigmatized. And it is rated as lacking with regards to ethics and honesty. For instance, one area in particular that is misunderstood and, therefore, seems to attract negative attention is the selling of a lifetime of chiropractic visits: unfortunately for the profession, this is perceived as a method to ensure a chiropractor’s income rather than as a health-care strategy with real benefits. However, chiropractors are not alone: other professions, including health-related fields, are looked upon as suffering from an erosion of professional ethics and values. It is suggested that many have forsaken their professional roots and regard their practices solely as a business with professionalism being of a lesser priority.

Professional success is as much about attitudes, and character, as it is about drawing and retaining a patient base. Advertisement

It is worthy of note that, as of late, there has been a renewed call for professionalism among all professions. Among the advocates for this renewal, many chiropractors are crying out that there is a need to live up to the tenets of professionalism, and the codes of ethics that are part parcel of their practices, and to inform the public that chiropractors are indeed professionals with high standards and values. In order to facilitate this  movement, it may be prudent to review the basics and remind ourselves what values and ethics we meant to uphold in the first place. 

WHAT IS PROFESSIONALISM?
Professionalism is best described as the relationship through which an adult person who has a high level of expertise and discipline in a chosen field – and who is a member of an organized group of likeminded individuals who also have a high level of expertise and discipline in this same field – cultivates trust with society and the patrons who avail themselves of that person’s services and expertise. The building blocks of professionalism include strong education in the chosen discipline, integrity, honour, leadership, autonomy, pride, collegiality and service, all balanced with a level of commercialism that should reasonably be expected. In the chiropractic profession, this includes both the relationship between a chiropractor and a patient, and the unwritten contract between the chiropractor and society. Another very important attribute is the ability to define and provide sound advice, competent service and a meaningful, lasting care relationship.

Chiropractors are, or should be, characterized by a strong commitment to the well-being of patients, high standards of ethical conduct, mastery of an ever-expanding body of knowledge and precision in utilizing their clinical skills.

Real professionalism also involves taking pride in one’s work, that is, understanding the potential one has to benefit others. It means making a commitment to using best practices to attain optimal outcomes, having a dedication to the interests of the patient, doing no harm and having a sincere desire to help. Professional success is as much about attitudes, and character, as it is about drawing and retaining a patient base. Positive attitude and good character are demonstrated through energy, drive, initiative, commitment, involvement and enthusiasm.

A COMBINATION OF MANY QUALITIES
Over the years, the role and the basic techniques of chiropractic have remained relatively constant. However, the concept of professionalism, to which all chiropractors aspire, has changed in response to societal needs and requirements. As the demands of society have become more intense and self-centred, an increased need for structure and organization has developed. Society grants professions privileges, including exclusive or primary responsibility for the training and education of its members, the providing of certain services, the setting of its own standards of performance and a high degree of self-regulation, while at the same time guaranteeing accountability in the matters of competence and professional behaviour. Because much of the required practice knowledge is not accessible to laypersons, a profession is granted autonomy to set standards but must also self-regulate and discipline unprofessional behaviour. In return, the profession agrees to use these privileges primarily for the benefit of others. As well, professionals are expected to be moral, objective, competent and accessible.

As we can see, then, professionalism does not mean wearing a suit, carrying a briefcase, driving a high-priced automobile or always having your cellphone at the ready. Nor does it mean having a collection of designations and diplomas that are meaningless to the public, which many crash course and seminar providers are far too anxious to hand out. It is not one quality, but a combination of qualities; not a skill but a blending and integration of a variety of skills and attributes. When demonstrated, it is thought to be “the entire package.”

ARE ETHICS COURSES MEANINGFUL?
All of the privileges and trust you enjoy as professionals is wonderful news, isn’t it? But how does a professional remain competent at balancing practical skills with the myriad other qualities – some less tangible or difficult to standardize – that (s)he is expected to espouse? How does one cultivate “the entire package” in oneself, as a professional?

To address some of these “intangibles,” continuing education courses where professionalism is broken down and explored, on a very practical level, may be useful. These courses should include not only an overview of ethical theories and issues for clinicians, but also a discussion of what the guidelines require of doctors in their respective jurisdictions.

However, there seems to be an ingrained negative reaction to compulsory ethics courses, especially if they are mandated by professional organizations, and a perception that pushing ethical principles and guidelines creates an environment of eroded trust and increased monitoring and accountability that goes against a professional’s privilege for autonomy.

In medical services of all types, there are many very competent, very conscientious and very honest practitioners who could justifiably call themselves “professional.” They demonstrate all the mandatory characteristics referred to above. However, with many, commercialism has taken over. To earn a good living is a common goal and a necessity, yet some of health care practitioners are given over to greed. Professional values are on the decline and fundamental ethical behaviour is losing ground. For instance, some practitioners are finding ways to justify squishing as many patients as possible into a workday – or unnecessarily prolonging or adding to diagnostic or treatment regimens – without adequate regard for whether they are, in fact, honouring each patient with optimal care. Other questionable behaviour may include billing practices that are not exactly aligned with the values of professionalism. 

And, so, the time has come to regroup and ensure that basic ethical principles are being ingrained into health-care professionals and that ethical guidelines are well recognized by all who aspire to work with patients as their career. When the profession can officially demonstrate that it has taken on the commitment, for itself and all of its members, to ensure optimal professionalism, then it can begin to counter public skepticism regarding the moral standpoint of chiropractic practices.

In Part 2, the term “Professionals” and the question “Can ethics be taught?” will be discussed. It will appear in the June 2013 issue of Canadian Chiropractor.

Lloyd Manning is a semi-retired business, commercial real estate appraiser and financial analyst. His newest book – Winning With Commercial Real Estate – The Ins and Outs of Making Money In Commercial Properties is available online from Indigo-Chapters. He can be reached at lloydmann@shaw.ca.